Permit ` PLUMBING PERMIT
CITY � �w���� �� � ���w��r-�����N��r � � ��'� � PERMIT #.......: PLM96—N069
DATE ISSUED: 04/11/96
COMMUNITY DEVELOPMENT DEPARTMENT
1o1uaew Hall Blvd. Tigard, Oregon m72o°w1en (5u3)e39-41r1 PARCEL: 1S135AB-01002
SITE ADDRESS...: 10220 SW GREENBURG RD #350
SUBDIVISION....: ZONING: R-12 •
BLOCK. .. .. ..... : LOT ^8
________
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE ^COM WASHING MACH..... . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP.. :B2 FLOOR DRAINS......: 0 TRAPS... ........... : 0
STORIES ~ 0 WATER HEATERS.....: 1 CATCH BASINS ^ 0
FIXTURES----- --- LAUNDRY TRAYS : 0 SF RAIN DRAINS ^ 0
SINKS..........: 1 URINALS : 0 GREASE TRAPS : 0
LAVATORIES..... : 0 OTHER FIXTURES.... : 0
TUB/SHOWERS....: 0 SEWER LINE (ft)...: 0
WATER CLOSETS..: 0 WATER LINE (ft) ...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft) ...: 0
Remarks: Tenant modification •
Owner: --- — FEES -------
MELVIN MARK BROKERAGE CO type amount by date recpt
10220 SW GREENBURG RD PRMT $ 25.00 B 04/11/96 96-278082
5PCT $ 1.25 B 04/11/96 96-278082
TIGARD OR 97223
• Phone *: 452-5900
Contractor: --- ----
CONTRACTOR NOT ON FILE
_
Phone #: $ 26.25 TOTAL
Reg #..:
REQUIRED INSPECTIONS
This pmrsit is issued subject to the regulations contained in the Top—out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved ploms. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
•
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Per mittee Signatur �Y~� ���lC$*- qr.
Issued By • OAALIMalf
Call for inspection — 639-4175
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13 SW Hall Blvd. Permit # Pry qlo-
Tigard, OR 97223 SWV- -1/0 -Di CI
(503) 639 -4171
& MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development C 64"4 35 New Single Family Residences Only
Addreu ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job /D 2Z0 s40 creep, 6 �p ❑ 3 BATH HOUSE $225.00
Address � .t. Fee includes all plumbing fixtures in the dwelling and the first 100 feet
/ ii 6N ? 7'&2 j of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of coolness) FIXTURES QTY PRICE AMT
Sink / 9.00 q
Meting Address tom. Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
C i /state MP Shower Only 9.00
Water Closet 9.00
Nay (or name ef esa) z0 � Dishwasher 9.00
- Garbage Disposal 9.00
Occupant Mdng Ad,. ' �'�/ Phone Washing Machine 9.00
ri',-,-w,.3 /0220 St) �fee V Floor Drain 9.00
Water Heater / 9.00 q,)
7 42:3 Laundry Room Tray 9.00
Na / � Urinal 9.00
/ / Other Fixtures (Specify) 9.00
M Address / Flume 9.00
Contractor /�/ e (kale, 9 1172 VI
7 9.00
Cgte 97207 Sewer 1st 100' 30.00
Bus.
State Registration No. City ,o. Tex t. Sewer - ea. Addit 100' 25.00
®c) fCD / ?/)/4 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given Is correct, that I am the owner or authorized agent of
the owner, that plans submitted are In compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti- Pollution Device 9.00
g •, a �, or spent) � /Ate Any Trap or Waste Not
!// iOi 1 1' . Connected to a Fixture 9.00
Describe work /' 0 addition 0 alteration fir repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr • Existing use of ' / Rain Drain, single family dwelling 30.00
building or property 11 r AKA A
/ Residential backflow prevention
If if devices 15.00
Proposed use of
building or property , *(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL L •!:b
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE I 1-5
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL 7,.(0,]i
TOTAL
Special Conditions
Date issued by
• I 0 ZZo Sw Greev■Lac�.(r�t ill . — ► a-l.I yes rEc�e . +,uve �yw -ct le 5. e�v�.
5 1
: Tenant Name. ( 41 I L. Accumulative Sewer Tally
35'U This SWR # 96 - 0(54
Address: 9 _1 6 _ _ L L._ P.l This PLM #: clo tap/
M
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub/Shower 4
- Jacuzzi/Whirlpool 4
• Car Wash - Each Stall 6
- Drive Through 16 •
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 'N(1.11 Z 4 Z y
1 - Domestic 2 .
-. Drinking Fountain 1
Eye Wash 1
Floor Drain/sink - 2 inch 2 DON LZ ZZ
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
• - Domestic (to 3/4 HP) 1 _ 1 to 1 • .
u - Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine/Refrigerator Drains 1 :4
• Oil Sep (Gas Station) 6
4 Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar/Lavatory 2
- Bradley 5
- Commercial 3 t'" l �j 1 3 ZZ Lo to
- Service 3
Swimming Pool Filter 1
7] Washer - Clothes 6
�1 Water Extractor 6
t Water Closet - Toilet 6
• Urinal . 6
TOTALS I Zc 7 'Po N's 12_
4
Total fixture values: 17-%
divided by 16 = 1 + � EDU
t. HISTORY
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